title: Obesity prevalence and unfavorable health risk behaviors among German kindergarten teachers: cross-sectional results of the kindergarten teacher health study.
abstract: BACKGROUND
  The aim of the study was to investigate obesity status and associated health risk behaviors in a sample of German kindergarten teachers. At present, such data are not available, despite the fact that kindergarten teachers educate children at a formative time in their lives.
  
  
  METHODS
  Kindergarten teachers aged 18-62 years (n = 313) were invited to participate in the Kindergarten Teacher Health Study (KTHS) by completing a self-reported questionnaire. We analyzed their obesity status, health risk behaviors (i.e., habitual physical activity, screen time activities, eating behavior patterns, smoking), and their general ability to identify overweight children and the associated health risks of overweight and obesity based on special age- and sex-specific silhouettes. After adjusting for covariates, bivariate correlations were conducted for associations between body mass index (BMI) and health risk behaviors, while analyses of variance (ANOVAs) were used to analyze differences of health risk behaviors between BMI groups. Logistic regression analyses were conducted to predict determinants of kindergarten teachers who did not correctly identify the overweight silhouettes and their associated physical and mental health risks. Additionally, data regarding kindergarten teachers' weight status and smoking behavior were compared with nationally representative data from the 2009 Microcensus (n = 371310) using the Mann-Whitney U-test.
  
  
  RESULTS
  The prevalence rates of overweight and obesity were 41.2% and 17.9%, respectively. The prevalence of obesity was significantly higher in kindergarten teachers (p < 0.001) compared to national Microcensus data. Only 44.6% of teachers were able to identify overweight children correctly. The fact that being overweight is associated with physical and mental health risks was only reported by 40.1% and 21.2% of teachers, respectively. Older kindergarten teachers were more likely to misclassify the overweight silhouettes, while younger, normal-weight, and overweight kindergarten teachers were more likely to underestimate the associated health risks. Obese kindergarten teachers reported spending more time in front of computer and television screens than their normal-weight counterparts, especially on weekends. In addition, obese kindergarten teachers reported eating less often with their families and more frequently reported watching television during meals.
  
  
  CONCLUSIONS
  Advanced monitoring and multifaceted interventions to improve the health behaviors of kindergarten teachers should be given high priority. Because kindergarten teachers' behavioral modeling presumably mediates children's health behaviors, additional research is needed about kindergarten teachers' health and its proposed interaction with children's health.
authors.affiliation: Department of Sports Medicine, Disease Prevention and Rehabilitation, Faculty of Social Science, Media and Sport, Johannes Gutenberg-University Mainz, Albert-Schweitzer-Str, 22, 55128 Mainz, Germany. simonpe@uni-mainz.de.
authors.forename: Sascha W
authors.initials: SW
authors.lastname: Hoffmann
authors.forename: Suzan
authors.initials: S
authors.lastname: Tug
authors.forename: Perikles
authors.initials: P
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004435:Eating; D005178:Faculty; D005260:Female; D005858:Germany / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D012309:Risk-Taking; D057566:Self Report; D013690:Television / Q000706:statistics & numerical data; D055815:Young Adult